Sugartax needed? | © benjamas11 @ Shutterstock

Sugar tax needed?

Background

Obesity and associated diseases | © Bray et al. (2017)
Obesity and associated diseases | © Bray et al. (2017)

Worldwide, it has been reported that there are an increasing number of people who are obese and/or suffer from type 2 diabetes. Evidence is growing that a connection exists between obesity, diabetes and the consumption of sugar. Many people ingest much more sugar than the WHO recommends as part of a balanced diet. More and more scientific research suggests that the consumption of liquid sugar, like soft drinks and fruit juices, leads to adverse health effects.

Many diseases are associated with obesity (figure[ref]Position Paper Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation Authors G.A. Bray, K.K. Kim, J.P.H. Wilding First published: 10 May 2017[/ref]). In 2015, 1.8 % of the global economic output was lost because of type 2 diabetes and its subsequent costs. The number of cases is increasing; experts expect an additional 500,000 diabetes cases per year in Germany alone. Diabetes is just one illness associated with obesity. Even higher income nations  with an effective health system must deal with the question how long health insurance can pay for the treatment of diabetes and other diseases caused by obesity.

Sugar tax models predict decrease in obesity cases

The question is whether politicians should intervene. The discussion focuses on the proposal to raise a “sugar tax” on soft drinks. Proponents hope that such a levy could lead to a drop in consumption. Scientific modelling supports this assumption:

Harvard modelling for Illinois and Philadelphia. The researchers predict that, for the state in the Mid-West with 12 million inhabitants, consumers will buy less soft drink if  they are charged a tax of 1 cent per fluid ounce. The modelling suggests that 116,000 obesity cases could be avoided and US$ 733 million in healthcare costs could be saved over a period of 10 years. Philadelphia has 1.5 million inhabitants. According to the researchers, a tax of 3 cents per ounce would avoid 2,280 diabetes cases per year and 36,000 obesity cases over a period of 10 years.

In Mexico, researchers expect that the sugar tax, introduced in 2014, will save 18,900 lives and US$ 983 million in healthcare costs. The University of Waterloo calculated a model for Canada. It found that, over a period of 25 years, a 20 % tax on soft drinks would deliver healthcare savings of US$ 11.7 billion, because 600,000 obesity cases and 200,000 diabetes cases could be avoided. The ife – Institute for Food Economics expects a total drop in consumption of one third as consequence of a sugar tax.[ref]Presentation at the Scientific Conference 2017 of the German Nutrition Society.[/ref]

Nanny state?

Obesity and diabetes cause worldwide harm and economic loss. According to the scientific modelling, the number of cases could decrease after the introduction of a sugar tax. WHO and the EU Commissioner for Health and Consumer Protection are in favour of this measure. Scientists from the University of North Carolina have already demonstrated that the tax is successful in Berkeley. After the tax was introduced on January 1, 2016, soft drink consumption decreased by 9.6 %. In Mexico, since 2014 soft drink sales have dropped by 12%. The question remains whether such a state intervention could be deemed too paternalistic.

The Institute of Economic Affairs (IEA) and the European Policy Information Centre (EPIC) developed a so-called “Nanny-State-Index” for the EU. The member states got points, related to different policies to address the consumption and promotion of unhealthy food and drinks: taxation, vending machines, energy drink regulations, advertising restrictions and mandatory limits. A state could reach the maximum of 100 points.

With 28 points is Hungary the leading “Nanny-State” in Europe. Hungary raised a tax on soft drinks and introduced limits for trans fats and salt in bread. In restaurants, sugar and salt on the tables are banned. The same is true for soft drinks and fatty meat in canteens.

France is ranked second. Its 11 points result mainly from a tax on soft drinks and energy beverages. Furthermore, the free refill of soft drinks has recently been banned. None of the other states got more than 10 points. For Germany, this is easily understood: There is no sugar tax – the food minister does not support the idea.[ref]The same is true for the Austrian health minister: http://www.kleinezeitung.at/lebensart/familie/5182084/RendiWagner_Gesundheitssystem-muss-sich-an-den-Menschen. In parts of Switzerland plans for a sugar tax do exist, e.g. to provide the cost for dental care for kids: https://www.nzz.ch/schweiz/gegen-uebergewicht-und-schlechte-zaehne-steuer-soll-zucker-bitter-machen-ld.152330. Not only softdrink producers are against it but also consumer advisors: https://www.aargauerzeitung.ch/schweiz/softdrink-hersteller-whren-sich-gegen-zuckersteuer-auch-konsumentenschutz-stellt-sich-dagegen-131322578[/ref] Energy drinks are sold without age restriction, nor are there limitations on advertising nor mandatory limits, e.g. for trans fats or salt in bread.

Conclusion

Globally, reducing obesity and diabetes is one of the greatest challenges of the 21st century. This goal can only be realised if people have a healthy diet and governments create a food environment that promotes healthy eating. So far, in Europe and probably worldwide, hardly any restrictions related to the long-term impact of food and drinks exist. In the public debate, the controversial issue is the question whether it is effective to provide more information for people to make up their own minds about what they eat or drink, or whether products with particular adverse health effects should be taxed. Few experts believe in the short-term effect of information campaigns. Thus, the sugar tax appears a realistic alternative. If, at the same time, taxes on healthy food were reduced (or even withdrawn), the tax burden for the people would remain the same.[ref]Garlichs, Dietrich, 2017: Prävention. Vom Leben im Schlaraffenland. In: Deutsche Diabetes Gesellschaft (Hrsg.): Geschäftsbericht 2016. Berlin[/ref]

Dr. Sabine Bonneck